Diseases of the Testicles.—The testicles, from their office and connexion with other structures equally as important, are liable to many excitations. In gonorrhœa they are subject to sympathetic inflammation, as inhernia humoralis, which, if neglected or maltreated, gives rise to abscess or chronic hardness. Inflammation also occurs in them as in other structures. Accidents, such as blows or bruises, horse-riding, wearing very tight pantaloons, are all fertile sources of derangement. Scrofulous constitutions are predisposed to have their testicles, like the rest of the glands, diseased. The most frequent disturbance, however, of the testicles, is a dilatation of the veins, constituting what is called varicocele; and generally accompanied by a wasting away of the testicle itself. It is rare, indeed, to find perfectly healthy testicles in an individual who has been exposed to amatory pleasures and sensualities; and as, of course, even amative desire, as well as amative power, depends upon the absolute sound condition of the glands in question, the inference is, that in very numerous persons, the sexual instinct is considerably diminished, and not unfrequently wholly suppressed, before half the natural term of their existence has expired, at which time they ought in reality to be at the climax of their prime and capability.
It is not so much a painful complaint, as an unpleasant one. There are occasionally pains in the back and loins, and other feelings, creating a sensation of lassitude and weariness; and now and then some local uneasiness is felt.
Varicocele gives to the examiner a sensation as though he were grasping a bundle of soft cords. It sometimes exists to such a degree as to resemble a rupture. In advanced stages of the disease, or disorganization, the epididymis becomes detached from the body of the testicle, and is plainly distinguishable by the finger. The result of all is, that a considerable diminution of sexual power takes place; and if means are not adopted to arrest a furtherbreak-up of the structure, the venereal appetite will subside altogether. The annexed drawing exhibits a tolerably faithful portrait of the disease; it represents the varicocele to be on the left side—the side most usually affected.
Described in surrounding textView larger image
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The folds formed by the veins lapping over each other are clearly distinguishable, and the dependent state of the scrotum on the affected side exhibits very well the occasion of it. The treatment consists in giving support by means of a suspensory bandage, which may be worn during the day, and the use of local refrigerants night and morning. The state of health is sometimes mixed up with it; and tonics and generous diet are useful. The cold shower bath helps to brace the system. It is a complaint in which, if it be not of very great severity, nor very long continuance, much good may be done. In some instances the veins may be allowed to empty themselves, which they will do when the body is in a recumbent position, and a coated ivory ring, or a silken band, may be so placed around them as shall prevent their refilling. It is, however, a case fitter for the surgeon’s management.
Abscess in the Testicle.—The testicle is subject to inflammation and suppuration like any other structure. A case about three years ago fell under my notice, where a quantity of dark fœtid fluid was released on puncturing a testicle in which the sense of fluctuation was very evident; and the patient stated that it had been five or six years in arriving at that condition. He was wasted considerably from nocturnal perspirations and acute pain, and his sexual desire was much diminished. The case did well, and the latter function was restored without much loss.
Hydrocele.—Hydrocele is an accumulation of yellow serous fluid in thetunica vaginalis testis(refer to the engravings in next page), or peritoneal covering of the testicle. It is a disease incident to every period of life, but more commonly met with in grown persons. The ordinary formation of hydrocele is unattended with pain; and the patientaccidentally discovers the existence of the swelling, but oftentimes not until it has attained a considerable magnitude. The tumor, when large, produces an unsightly appearance, and forms a hindrance to sexual intercourse, from the integuments of the penis being involved therein, and thereby preventing a perfect erection of that organ. The disease may appear to originate spontaneously; but it is usually traceable to some bruise, blow, or other external injury to the part.
The two following drawings exhibit the outward and inward appearance of the scrotum inhydrocele:—
The Scrotum largely distended.View larger image
The Scrotum largely distended.View larger image
The Scrotum largely distended.View larger image
The Scrotum largely distended.View larger image
The Scrotum largely distended.
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The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.View larger image
The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.View larger image
The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.View larger image
The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.View larger image
The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.
View larger image
The notion that the cure of hydrocele depends on promoting adhesion to the sides of the tunica vaginalis with the testicle is somewhat upset by several preparations in the London hospitals, exhibiting thetunictaken from persons in whom a radical cure was effected by injection, and in whom no fluid was reproduced; nor were the sides of the said investment at all adherent with the testicle, but apart, as in the healthiest individual. Hitherto surgeons,acting on the aforesaid notion, with a view to obliterate the cavity, adopted various plans of treatment—such as, for instance, laying open the entire cavity, cutting away a portion of the tunica vaginalis, the application of caustic, and, lastly, the seton, as advised by Dr. Pott, which was suffered to liberate itself by ulceration. When, in any of these instances, suppuration was induced, the cavity became in time filled up by the granulating process. The plan of the present day is by perforating the sac with a trocar, suffering the effused fluid to escape, and injecting some stimulating liquid which is allowed to remain until a degree of inflammation is produced, that shall cause an obliteration of the cavity by adhesion, or, as it has also been proved, prevent a reproduction of the fluid, by closing the mouths or altering the diseased action of the exhalent arteries. Whichever be the effect produced thereby, the cure is almost certain, and the principles of the treatment consequently judicious. But, notwithstanding, the operation is not always immediately, norultimatelysuccessful; the degree of inflammation set up may be insufficient, and the effusion again take place, and the operation may require a second and third repetition; or an excessive degree of inflammation may ensue, that shall occasion serious constitutional disturbance, either by suffering the injected fluid to remain too long, or its being of too stimulative a character, or from its escaping into the cellular membrane of the scrotum, an accident not unfrequent, unless great care be used in the operation.
Radical Cure of Hydrocele.—The term radical is applied to the process narrated in the last case; but, as has been observed, the operation is occasionally required to be repeated several times. In the case I am adverting to, after tapping, several injections were thrown in between the tunics, and withdrawn; and on one occasion the morbid fluid was secreted to the greatest possible distension of the scrotum by the following morning. Its subsequent withdrawal, and the injection of a more active stimulant, effected, however, a permanent cure. In the country, surgeons frequently plunge a lancet in the scrotum, suffer the effused liquid to escape, and desire the patient merely to wrap the parts up in a handkerchief, to take no further heed, and to ride home: and these cases generally do well.
Hydrocele Cured by Acupuncturation.—A new method oftreating hydrocele has of late years been introduced, namely, by the insertion of a needle into the sac or bladder of the testicle, which, upon its withdrawal, permits the fluid to escape into the cellular membrane, whence it is rapidly absorbed. A pint of fluid may be got rid of in that way in two or three hours; and, although the disease may not be radically cured, it will occupy several months before a reaccumulation of the fluid takes place. In recent cases, this treatment oftentimes proves permanently successful. Many nervous persons will not submit to anything approaching an operation, not even to the simple one of acupuncturation. In such cases, there is no alternative but counter-irritants, to be applied over the part, such as the tincture of iodine, or the following ointment (Form26).
It is at all times best to attend early to any disease of the testicles; the progress is so rapid, the mischief so great, and the consequences so deplorable, of uncontrolled disease.
Eruptions incident to the Organs of Generation and the Rectum.—The structures included in the above heading are subject to a variety of eruptions, varying in character, intensity, and duration. Thus we have thepapular, a chronic inflammation characterized by papules, or very minute pimples, of nearly the same color as the skin, accompanied by intense itching, and terminating, when broken by scratching, in small circular crusts: this is called, by dermoid pathologists, Prurigo. Another order of eruption is designated thevesicularandpustular, and consists of groups of small pimples of a very bright red color, and containing a serous fluid. They are accompanied by itching, which increases as the contained humor becomes turbid, and assumes the puriform aspect; they then incrustate, and at the end of about a fortnight drop off, leaving the skin healthy underneath. The name given to this variety is Herpes.
The last and most inveterate species is characterized by an itching of the skin, which, on inspection, appears of adiffused redness, and gives off, after a while, a number of thin scales: these reaccumulate, and the entire organs of generation becomes sometimes covered with similar patches: this is denominated Psoriasis. These affections, which are but various degrees of inflammation, modified by idiosyncrasy and habit, arise from local and constitutional causes. Among these are frequent excitation of the organs of generation, the contact of the fluids secreted during sexual intercourse, an unhealthy and relaxed condition of the genitals, and, lastly, a disordered state of the digestive organs. It is astonishing to what an extent these disorders prevail, and more so to find how long the individuals, probably from a sense of diffidence in seeking professional assistance, endure them. I have encountered many patients who have informed me that they have had the complaint upon them from five to ten years, purposing during the whole of that period to consult some medical friend, but postponing it until their interview with myself; and it is the more to be regretted, as the cure may always be effected in a week or two, with moderate attention and perseverance; but if the attempt be neglected, there is no limiting the extent to which the disease may proceed. Local diseases, especially of such a nature as those under consideration can not exist any great length of time without involving the digestive organs, which become sympathetically deranged; and in like manner do local diseases participate with dyspeptic disturbances—each, therefore, goes on aggravating the other.
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